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Vaccine Refusal & Exemption Forms
 
  • Affidavit for Parents Participating in International Adoption (Word) (pdf)

 

  • Childcare and School Immunization Requirements This 39 page pdf contains State immunization policies that were validated in August, 2006. Document reflects state laws, regulations, or rules for vaccination requirements for enrollment and/or attendance in day care, Head Start, kindergarten, grades 1 through 12, colleges, and universities.  Some maps are included for comparison purposes.

 

  • Hep B vaccine in hospital for newborn refusal, sample (pdf)

 

 

  • Religious exemption letter that was approved in Florida (Word) (pdf)

 

  • School Vaccine Exemption Form, sample (Word) (pdf)

 

  • State Immunization Laws Searchable Database This tool contains results from a 50-state legislative review of laws requiring assessment of vaccination status and vaccine administration for healthcare workers and patients/residents.  The review was conducted by CDC in 2005 and collected data on laws for the following types of facilities: hospitals, ambulatory care facilities, individual providers' practices, correctional facilities, and facilities for the developmentally disabled.

 

  • TB testing refusal, sample (pdf)